Teaching about recurrent fevers in a small-group setting

This is video from a small-group teaching session that I led based on the case of a child with recurrent fevers. This case was done as part of my Rabkin Fellowship in Medical Education. I would appreciate your feedback on this teaching session!

Great tutorial It was so clear and concise and this group will never forget Periodic fever syndrome.. took 17 years to diagnose my son and you can summarize it in a short lecture. He has been diagnosed as having periodic fever which behaves like TRAPS but seems to be responding to Colchicine. Because auto inflammatory diseases are rare a lot of doctors know nothing about them.He has been diagnosed with so many illnesses- mainly .”it’s a virus”, appendix, throat problems naturally, When he has chest pain-pneumonia even though the chest x-ray was clear, Pylonephritis but nothing was cultured. He had his appendix removed once as he had all the symptoms and then later a young intern diagnosed him with appendix again.even though he had the surgical scar. We always knew ourselves that it had a pattern and all the illesses were all all part of the same thing. Our third son started to show symptoms at about 9yrs not diagnosed yet he has lots of symtoms but very rarely has fevers. terrible pains in the big joints. one thing we have found very useful is that we had his notes bloods photos of rashes into a folder on dropbox so when he became very ill and was admitted to icu they accessed his file on the way in the ambulance.

Thanks for watching the video! I agree that many physicians are unfamiliar with periodic fever syndromes, and that’s part of the purpose of my blog–to teach physicians and patients about these diseases. We often find it difficult to assign specific names to the diseases that we see, because many patients, like your son, don’t seem to follow any specific patterns. Fortunately, we’re learning more about these diseases every day, and I’m confident that one day we’ll have a much better understanding–and treatment–of these disorders!

Our twenty three year old daughter has had a daily, everyday, fever, for a year, as of today March 9. (104.5°)She has taken.6mg/twice a day for two months, with no change, even though she did not test positive for fmf. Prior to this, constant fevers and infections over her life. A million tests, still no answers. High iGe,8000, many negative tests for job’s and dock 8. Doctor gave her a months worth of steroids today for possible stills. She’s had the bone marrow biopsy, she went to Cleveland Clinic, from Cincinnati, she’s had repeated mri’s. She was treated for juvenile arthritis when little, with swelling in ankles and knees. AND like your sample patient, played intense soccer, until 14 years, after having knee surgery and 12 surgeries to close wound over 18 months with infections. Then later 18 months of mrsa… thanks for teaching anything!

Wow, shows you how little doctors know about these diseases, doesn’t it? Sounds like she has had very appropriate follow-up over the last few years. There are many diseases that we haven’t yet named, diseases we haven’t even recognized. However, I think that little by little we’re making progress, and I think that doctors and patients, working together, will eventually find answers to your daughter’s case, and to many other unsolved mysteries! Good luck, and please let us know how she does!

Thanks for sharing. Really nice lecture. Reminds me of my experience at age 4-6yo, too (URI, bronchitis or pneumonia every 1-2 months), but for me, it was probably due to malnutrition at that time and I got over these after 7yo, somehow…

From a med student perspective, I appreciate the way you guided the brainstorm process and summarized the ddx. In this situation, the differential could be quite broad, and it might be important to set a framework for that. The framework that works for me is “infection, rheumatology (autoimmune, autoinflammatory), malignancy, hereditary/congenital dz, endocrinologic/electrolytes, structural changes/trauma, iatrogenic” in this case (in the order of likelihood). These categories may have some overlaps but they will force me to think in a more thorough way (although the thoroughness is also determined by knowledge and experience, which is something I need to work on for my life). I think it might be beneficial to bring about a framework for ddx before the brainstorm so that people may think in a more organized way. It’s just my thought and from my limited experience, and it might not be right.

Again, thanks for sharing. I hope you will share with us more lectures like this and I will definitely follow.

I would love to see the rest of this lecture! I was upset it ended after fifteen minutes! Do you have a link to this entire lecture?? I have a seven year old periodic fever syndrome daughter being treated at Boston children’s, suspected HIDS. I love any information and research I can find. Thanks!